Shortfalls in funding for mass campaigns has sometimes resulted in the re-allocation of ITNs from routine ITN distribution channels to fill gaps in campaigns[1], causing stock outs and the suspension of the ANC and EPI ITN delivery. Although universal coverage mass campaigns can, in theory, benefit pregnant women and children, many campaigns take months, or even years, to fully roll out across all the regions or districts in a country. Therefore, many pregnant women and children who might otherwise obtain an ITN through routine health services cannot do so if they are waiting for a campaign to reach their area. Moreover, ITN distribution has been observed to increase pregnant women’s attendance at ANC clinics. It also sends a powerful message to mothers about the importance of using an ITN during pregnancy. As a result, it is vital to continue routine ITN distribution during mass campaigns to ensure that pregnant women benefit from the whole range of antenatal services and to encourage them to use an ITN.

In response to this trend, WHO updated its guidance in 2013 to emphasize the importance of rolling out ITN distribution through ANC and EPI services and ensuring these channels are functional throughout the process of planning and implementing a mass campaign. Specifically, the document states that “in order to maintain universal coverage, countries should apply a combination of mass free distributions and continuous distributions through multiple channels, in particular antenatal and immunisation services” (emphasis added). Moreover, “continuous distribution channels should be functional before, during, and after the mass distribution campaigns to avoid any gap in universal access to ITNs[2].”

To balance the need between universal coverage and prioritizing access for pregnant women and children, countries need to plan their funding commitments at least two years in advance to ensure enough ITNs are available for both routine distribution and mass campaigns. If a commodity gap remains, routine distribution should remain prioritized for many of the reasons outlined on Universal Coverage: pregnant women and children under 5 years are biologically vulnerable to malaria. Delivering ITNs through antenatal care enables women to access the nets as early as their first trimester. Promoting health facility-based distribution encourages pregnant women and caregivers to seek ANC and EPI services, thus ensuring their access to other life-saving services[3].

VectorWorks is funded by the President’s Malaria Initiative under the terms of USAID/JHU Cooperative Agreement No: AID-OAA-A-14-00057. The contents do not necessarily reflect the views of USAID or the United States Government.